OBJECTIVE:To investigate therapeutic efficacy and safety of linezolid and teicoplanin in the elderly patients with severe MRSA infection. METHODS:97 elderly patients with severe MRSA infection were collected and divided into linezolid group (42 patients) and teicoplanin group (55 patients). Linezolid group was given linezolid 600 mg intravenously,bid;teico-planin group was given teicoplanin 400 mg intravenously,qd,double dose for the first day. Treatment course lasted for 7-21 d. Clin-ical effective rate,bacterium clearance rate and ADR were compared between 2 groups after treatment. RESULTS:The bacterium clearance rate of teicoplanin group was 52.6%,and that of linezolid group was 73.5%;the linezolid group was significantly higher than the teicoplanin group,with statistical significance(χ2=12.57,P=0.034). Clinical effective rate was 78.6% in linezolid group and 58.2% in teicoplanin group;the linezolid group was significantly higher than the teicoplanin group,with statistical significance (χ2=9.56,P=0.018). After 14 days of treatment,APACHEⅡ score of teicoplanin group and linezolid group were (14.56±3.04) and(10.29±4.84),respectively;the teicoplanin group was lower than the linezolid group,with statistical significance(t=10.97, P=0.014). The incidence of ADR was 11.9% in linezolid group and 20.0% in teicoplanin group,with statistical significance(χ2=1.13,P=0.287). CONCLUSIONS:Linezolid has superior curative effect to teicoplanin in the treatment of severe MRSA infection in elderly patients with good safety.

BACKGROUND: Interleukin-6 (IL-6) is a cytokine produced in the process of organic immune activities. The problems still need further exploration, including whether the changes of serum level of IL-6 after clozapine treatment ware induced directly by the drug, and whether IL-6 is directly correlated with the changes of the psychiatric symptoms in female patients.with first-episode schizophrenia.OBJECTIVE: To explore the changes of the serum level of IL-6 and its relation with the dose of clozapine and the amelioration of the symptoms in female patients with first-episode schizophrenia.DESIGN: A non-randomized case-control observation synchronically.SETTING: Department of Psychiatry, Second Affiliated Hospital of Xinxiang Medical College.PARTICIPANTS: Twenty female patients with first-episode schizophrenia (patient group) were selected from Henan Psychiatric Hospital. They all met the diagnostic standards of schizophrenia in the 3rd edition of Chinese Classification and diagnostic criteria of Mental Disorders (CCMD-3), their score of positive and negative syndrome scale (PANSS)was above 60 points, and had not been treated or at least not taking medicine for 2 weeks during clinical treatment.Patients with physical disease, endocrine and immune system diseases, malnutrition and other mental problems, those with the history of being allergic and hormone treatment, those receiving immune pharmaceutical treatment, and recently having been vaccinated preventively, and the pregnant and breast-feeding women were excluded. Twenty healthy female volunteers, who had no significnat difference in age and gender from the subjects in the patient group,were taken as the control group, and the exclusive standards were the same as those in the patient group. All the subjects were enrolled with the approval of themselves and their guardians.METHODS: All the patients were adminsitrated with clozapine only, with the dose being added by 25-50 mg per day,and the maximal dose was reached within 3 weeks. The principle for the administration was the maximal effectiveness and the minimal side effect. ① Serum level of IL-6 in the patient group was detected using enzyme-linked immunoabsorbent assay (ELISA) before treatment and at 1, 2 and 4 weeks after treatment respectively. ② High performance liquid chromatography (HPLC) was used to determine the content of clozapine, and the levels of IL-6 in serum of the controls were taken as controls. ③ Correlations were analyzed in the patient group between the serum level of IL-6 before treatment and at 1, 2 and 4 weeks after treatment and the PANSS scores (scores of positive and negative symptoms, and general pathology, and the total score) at corresponding time points.MATN OUTCOME MEASURES: ① Serum levels of IL-6 before treatment and at each time point after treatment; ②Correlation analysis between the serum levels of IL-6 and clozapine content; ③ Correlation analysis between changes of schizophrenic symptoms and serum levels of IL-6.RESULTS: ① Serum level of IL-6 before treatment in the patient group was significantly higher than that in the control group [(137.72±18.84), (65.05±20.95) ng/L, t =11.53, P ＜ 0.01], those in the patient group at 1, 2 and 4 weeks after treatment were significantly lower than that in the control group [(28.11±5.42), (8.48±1.14), (13.90±2.55), (65.05±20.95) ng/L, t =7.63, 12.01, 10.84, P ＜ 0.01]. ② Correlation analysis between the serum levels of IL-6 and clozapine content: The results showed that the serum level of IL-6 had no significant correlation with the clozapine content at 1, 2and 4 weeks after treatment (r =-0.15, 0.12, -0.29, P ＞ 0.05). ③ Correlation analysis between IL-6 level and schizophrenic symptoms: In the patient group, there was significant positive correlation before treatment between the serum level of IL-6 and the score of positive symptoms (r=0.386, P＜ 0.01), and there was no significant correlation between the serum level of IL-6 and the total scores of PANSS and each factor scores at 1, 2 and 4 weeks after treatment (r=0.136-0.237, P ＞ 0.05).CONCLUSION: The serum level of IL-6 in female patients with first-episode schizophrenia was higher than that in healthy females, and it could be decreased by clozapine, and the amelioration of the schizophrenic symptoms had no significant correlation with the changes of IL-6 levels.

Objective To investigate the indications and efficacy of endovascular stenting for the treatment of thoracic aortic aneurysm.Methods From March 2005 to October 2008,21 patients with Stanford type B aortic dissection,5 cases of pseudoaneurysm,and 2 patient with intramural hematoma complicated with ulcer of the aortic wall were treated by endovascular stenting under general(2 cases) or local(26 cases) anesthesia in our hospital.Medtronic Talent stent was employed in 10 cases,Medtronic Valiant stent was used in 12,and microinvasive straight-type stent was used in 6 patients.Results The operation was completed successfully in all of the 28 cases.Angiography showed that the gaps in the aorta were closed without endoleak.No patient had chest pain or neurological complications.The patients were discharged in(4.5?1.1) days(range 3-7 days).Five patients developed fever after the operation and were cured by indomethacin in one month.One week after the surgery,in 21 cases,CT scan showed enlarged aortic dissection,improved blood supply,thrombus in the false lumen of the thoracic aorta,and a false lumen in the abdominal aorta.In the 5 cases with pseudoaneurysm,CT scan confirmed that the rupture was closed with thrombus being detected in the lumen.The aortic ulcers that were detected in the 2 cases,who had intramural hematoma,were covered by the stents.Of the patients,a follow-up of(21.3?10.2) months(range 1-40 months) was available in 23 patients,who had no complications during the period.Conclusions Endovascular stenting is a simple,safe and effective method for Stanford type B aortic dissection,pseudoaneurysm,and intramural hematoma,resulting in quick recovery,less complications,and short hospital stay.

Objective To explore relationship between the changes of mononuclear cells (MNCS) apoptosis and the levels of inflammatory cytokines and adhesion molecules in patients with systemic lupus erythematosus(SLE). Methods The apoptotic rates of MNCS in 32 patients with SLE and 10 healthy subjects were detected with flow cytometry, and the plasma levels of inflammatory cytokines(IL-8, IL-6,TNF-? and NO) and adhesion molecules(P-Sel, ICAM-1) were assayed with ELISA. Results The percentage of MNCS apoptosis in the patients with active stage of SLE was obviously higher than that in healthy subjects and patients with remission stage of SLE, and there was no significant difference in the percentage of MNCS apoptosis between healthy subjects and patients with remission stage of SLE. The levels of plasma IL-8, TNF-?, IL-6, NO, P-sel and ICAM-1 in patients with active stage of SLE were significantly higher than those in healthy subjects and the patients with remission stage of SLE, and were positively correlated with the percentage of MNCS apoptosis and the severity of SLE.There was no significant difference in the levels of plasma inflammatory cytokines and adhesion molecules between patients with remission stage of SLE and healthy subjects. Conclusion The apoptotic rate of MNCS increased in the patients with active SLE, and was closely associated with the severity and efficacy of SLE. The high expressions of inflammatory cytokines and adhesion molecules may be the reason of MNCS apoptotic increase. Appropriately regulating the expression of cytokines and adhesion molecules, and moderately controlling the apoptosis of MNCS may improve the prognosis of SLE.

Objective To investigate the clinical efficacy of the self-retaining laryngeal microsurgical operation in the treatment of Reinke ’ s edema of vocal cords . Methods There were 24 cases of Reinke ’ s edema who were treated with self-retaining laryngoscope mucosal stripping surgery of vocal cords from January 2004 to December 2009 ( traditional group ) , while another group of 32 cases of Reinke ’ s edema were treated with self-retaining laryngoscopic microsurgery lateral submucosal incision micro-flap operation of vocal cords from January 2010 to December 2015 ( laryngeal microsurgery group ) .The two groups were executed with electronic laryngoscopy and subjective voice evaluation GRBAS ( The Speech and Language Institute of Japanese in 1979, G: Grade, R:Roughness, B:Breathness, A:Asthenia, S:Strain) in pre-operation and post-operation (1 week, 3 weeks, 8 weeks).The wound healing time of vocal cords , hoarseness improved time and voice improvement were retrospectively compared between the two groups . Results The patients in laryngeal microsurgery group had earlier voice hoarse improvement and more rapid mucosal epithelial of vocal cords recovery time in post-operation as compared with the patients in the traditional group [voice improving time, (7.3 ±1.9) d vs. (11.3 ±2.7) d, t=-6.481, P=0.000;mucosal epithelial of vocal cords recovery time , (12.2 ±3.1) d vs.(20.1 ±3.4) d, t=-9.062, P=0.000].The results of pre-operative voice evaluation with GRBAS showed no significant differences between the two groups, but the results of post-operative evaluation of each session (1 week, 3 weeks, 8 weeks) showed that the main data were statistically different.The GRBAS score of laryngeal microsurgery group was lower than that of traditional group in post -operation, especially after 8 weeks (8 weeks after post-operation, G:1.0 ±0.8 vs.1.6 ±0.2, t=-3.584, P=0.000; R:1.0 ±0.9 vs. 1.5 ±0.4, t=-2.536, P=0.014;B:1.0 ±0.6 vs.1.4 ±0.5, t=-2.647, P=0.011).In laryngeal microsurgery group, 24 cases were cured , 5 cases were effective and 3 cases were invalid , contrasting in the traditional group with 11 cases of cured , 7 cases of effective and 6 cases of invalid respectively, with a significant difference (Z=-2.239, P=0.025).No significant difference in effective rate between the two groups [90.6%(29/32) vs.75.0%(18/24),χ2 =1.459, P=0.227]. Conclusion The clinical efficacy of self-retaining laryngoscope microsurgery in the treatment of Reinke ’ s edema of vocal cords is faster and better comparing traditional operation , with a more significant pronunciation quality improvement .

To investigate the clinicpathologic features and the main point of differential diagnosis of T-cell lymphomas in breast. MethodsTwo cases of T-cell lymphomas of the breast were analysed about clinic data, histopathology and imrnunochemistry. ResultsBoth of the patients were women whose age were 37 and 31 years old. Histopathologically, the tumor cells appeared sheet and cord-like arrangements. Some of them distributed around the blood vessel. There was an obvious phenomenon closing blood vessel. Tumor ceils were characterized by less cytoplasm, big and distorted nucleus, thin chromation. Large pieces of necrosis were observed. There were no lympho-epithelial lesions. Immunnohistochemistry showed that CD45, CD45RO, CD3 and CD43 in the tumor cells were all positive, while CD20 and CD74 were negative. Follow-up results showed that one died two and half months after operation and the other died sixteen months after operation. ConclusionsT-cell lymphoma of the hreast is the high malignant tumur which is extremely rare, and its diagnosis mainly depends on the histopathology and the marker of immunohistochemistry.

Objective To investigate the effect of different concentrations of arsenic trioxide (As2O3,ATO) on neurokinin A (NKA) in renal tissue of BXSB mice and explore its clinical value.Methods Fifty BXSB mice (twelve weeks old and weighted 23～26 g) were randomly divided into control group,systemic lupus erythematosus (SLE) group,and therapeutic group of three different concentrations of ATO.All biochemical indicators were analyzed before and after treatment.The pathology of renal tissue was examined by immunohistochemistry.The concentration of NKA in renal tissues was detected by ELISA and the concentration of NKA mRNA was detected by RT-PCR.Results The concentration of NKA in SLE group in renal tissue (299±26) pg/g was significantly higher than that of normal control group (122±7) pg/g (P＜0.05).The concentration of NKA in the SLE group in renal tissue was significantly higher than that of three different concentrations of ATO in low-dose group (151±14) pg/g,moderate--dose group (147±9) pg/g and in highdose group (155±14) pg/g (P＜0.05).No difference was found between three different dosages of ATO treatment groups and normal control groups (P＞0.05).There were no significant differences among three different dosages of ATO treatment group (P＞0.05).The side effects in low-dose group were significantly lower than those of moderate and high-dosage groups (P＜0.05).Conclustion NKA concentration expressed in the renal tissues in the SLE group is higher than that in the control group.Decreasing the concentrations of NKA mRNA in renal tissues may be one of the important mechanisms of ATO in treating SLE.Low-dosage ATO is safe and effective to treat SLE and has therapeutic potentials.

Objective To observe the changes of mononuclear cell (MNCs) apoptosis and the level of inflammatory cytokines and adhesion molecules in patients with systemic lupus erythematosus (SLE) and to study the relationship between them. Methods The apoptosis of MNCs in 22 patients with SLE at the active stage and 10 patients with SLE at remission and 10 healthy controls were determined with flow cytometry. The inflammatory cytokines and the adhesion molecules were tested with ELISA method. Results The percentage of MNCs apoptosis in the patients with SLE at the active stage was significantly lower than that of healthy con- trols and the patients with SLE at remission. There was no significance difference of MNCs apoptosis between healthy controls and patients with SLE at remission. The levels of IL- 8, TNF-?, IL- 6 , NO, P- sel and ICAM- 1 in patients with SLE at the active stage were significantly higher than that of healthy controls and the pa- tients with SLE at remission, and the increased levels of inflammatory cytokines and adhesion molecules in ac- tive SLE patients were negatively correlated to the percentage of MNCs apoptosis and positively correlated to the severity of SLE. Conclusion The data demonstrates that there is a promote apoptotic process of MNCs in active SLE. The high expression of inflammatory cytokines and adhesion molecules may play an important role of promoting MNCs apoptosis which reduces the functional life span of MNCs. For this reason, modulating the expression of cytokines and adhesion molecules and moderately controlling the apoptosis of MNCs may be a new therapeutic target for SLE treatment.

Objective To investigate the clinical application of temporary balloon occlusion of the common iliac artery in performing cesarean section for patients with pernicious placenta previa and placenta accreta.Methods A total of five cases with ultrasound or MRI diagnosed pernicious placenta previa and placenta accreta were analyzed retrospectively.One of the cases was diagnosed Rh(-)blood type.Prophylactic temporary balloon implantation in bilateral common iliac arteries were carried out before cesarean section.Digital subtraction angiography ensured the position of balloon catheter and the catheter was fixed.The balloon was inflated immediately after the removal of the fetus.The balloon was removed at 6-8 hours after the cesarean section.The amount of blood loss,transfusion requirement,cesarean hysterectomy rate, and X-ray exposured time and dose during the procedure were recorded.Results Temporary balloon implantation in bilateral common iliac arteries in all five patients were obtained successfully.The blood loss was seen <500 mL in one patient and 500-1 000 mL in other four patients.Because of placenta implantation over depth of serosa and placenta percreta in one case,massive intractable hemorrhage occurred in short time,partial hysterectomy had to be carried out.The uterus was retained in other four cases.Conclusion The temporary balloon occlusion of the common iliac artery in performing cesarean section is a safe and effective technique,and it can reduce the amount of blood loss,transfusion requirement and secondary risk due to uncontrollable bleeding during surgery.

Objective To investigate changes in the intraocular pressure(IOP) and anterior chamber angle in patients with chronic renal failure before and after hemodialysis. Methods Fifty?eight patients(116 eyes) with chronic renal failure were measured with Goldmann applanation tonometer and anterior segment optical coherence tomograph. The patients were divided into three groups based on gonioscopy results:the narrow angle group(22 eyes),the Iris neovascular group(3 eyes)and the open angle group(91 eyes). IOP was measured by Goldmann applanation tonometer in patients in the three groups before and after hemodialysis. Anterior chamber angle opening distance (AOD) was detected by anterior segment optical coherence tomograph before and after hemodialysis. The blood urea nitrogen,creatinine,albumin were also determined before and after hemodialysis. All changes in the parameters were analyzed with a paired t test. Results The IOP in narrow angle eyes and in neovascular eyes increased significantly after hemodialysis ,while the IOP in open angle eyes showed no significant changes. The AOD decreased significantly after hemodialysis. The blood urea nitrogen and creatinine decreased significantly in 58 patients,while albumin increased after hemodialysis. Conclusion The IOP in narrow angle eyes and in neovascular eyes increased after hemodialysis ,correlating with the resistance increase of aqueous outflow pathway and the change of plasma osmotic pressure. As a result ,it is recommended that the condition of eye of patients with chronic renal failure should be checked ,and patients should receive appropriate controlling measure or treatment before hemodialysis.